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High-Yield Nursing Pharmacology Drug Guide

The 25 most-tested NCLEX medications on quick-reference cards – drug class, use, key nursing considerations, and the single safety pearl most likely to show up on your exam (antidotes, labs to monitor, toxicity signs).

heparin

anticoagulant (unfractionated)

Use: prevention and treatment of venous thromboembolism and pulmonary embolism

Monitor aPTT every 6 hours; therapeutic range is 60 to 100 seconds (1.5 to 2.5 times control)
Assess for bleeding: hematuria, black tarry stools, unusual bruising, and gum bleeding
Never administer intramuscularly due to risk of hematoma; use subcutaneous or IV routes only
Have protamine sulfate available as the reversal agent

Key point: Antidote is protamine sulfate; monitor aPTT to guide dosing

warfarin (Coumadin)

anticoagulant (vitamin K antagonist)

Use: prevention of thromboembolic events in atrial fibrillation and mechanical heart valves

Monitor INR; therapeutic range is typically 2.0 to 3.0 (2.5 to 3.5 for mechanical valves)
Teach patient to avoid foods high in vitamin K such as leafy green vegetables and maintain consistent intake
Many drug interactions; NSAIDs, aspirin, and antibiotics can increase bleeding risk
Instruct patient to use a soft toothbrush, electric razor, and report unusual bleeding

Key point: Antidote is vitamin K (phytonadione); monitor INR regularly

insulin (regular and NPH)

antidiabetic hormone

Use: management of type 1 and type 2 diabetes mellitus and diabetic ketoacidosis

Monitor blood glucose before administration; hold and notify provider for hypoglycemia
Rotate injection sites within the same region to prevent lipodystrophy
Regular insulin is the only insulin that can be given intravenously
Teach patient signs of hypoglycemia: shakiness, diaphoresis, confusion, and tachycardia

Key point: Only regular insulin is given IV; hypoglycemia is the primary safety concern

digoxin (Lanoxin)

cardiac glycoside

Use: management of heart failure and rate control in atrial fibrillation

Check apical pulse for one full minute before administration; hold if less than 60 beats per minute
Monitor serum digoxin level; therapeutic range is 0.5 to 2.0 ng/mL
Hypokalemia increases risk of digoxin toxicity; monitor potassium levels
Teach patient to report nausea, vomiting, visual changes (yellow-green halos), and bradycardia

Key point: Hypokalemia potentiates digoxin toxicity; antidote is digoxin immune Fab (Digibind)

furosemide (Lasix)

loop diuretic

Use: treatment of edema associated with heart failure, renal disease, and hypertension

Monitor serum potassium; furosemide causes potassium wasting and can lead to hypokalemia
Assess blood pressure before and after administration; risk of orthostatic hypotension
Monitor intake and output and daily weight to assess fluid balance
Ototoxicity (hearing loss) can occur, especially with rapid IV infusion or high doses

Key point: Monitor potassium levels; ototoxicity risk with rapid IV administration

metoprolol (Lopressor, Toprol-XL)

selective beta-1 adrenergic blocker

Use: treatment of hypertension, angina, and heart failure

Assess heart rate and blood pressure before administration; hold if heart rate is less than 60 or systolic BP is less than 90
Do not abruptly discontinue; taper gradually to avoid rebound hypertension and angina
Use caution in patients with asthma or COPD; can cause bronchospasm even though selective
Monitor blood glucose in diabetic patients; beta blockers can mask hypoglycemia symptoms

Key point: Never stop abruptly; taper to prevent rebound hypertension and potential myocardial infarction

lisinopril (Prinivil, Zestril)

ACE inhibitor

Use: treatment of hypertension, heart failure, and diabetic nephropathy

Monitor for dry, persistent, non-productive cough which is the most common side effect
Monitor serum potassium and renal function; can cause hyperkalemia and renal impairment
Contraindicated in pregnancy (category D/X); can cause fetal renal damage and death
Monitor for angioedema: swelling of face, lips, tongue, or throat requiring immediate discontinuation

Key point: Angioedema is a life-threatening adverse effect; contraindicated in pregnancy

morphine sulfate

opioid analgesic (narcotic)

Use: management of moderate to severe acute and chronic pain

Monitor respiratory rate; hold if less than 12 breaths per minute and notify provider
Assess pain level, sedation level, and level of consciousness before and after administration
Have naloxone (Narcan) available at bedside for respiratory depression reversal
Monitor for constipation and implement bowel regimen; opioids slow GI motility

Key point: Antidote is naloxone; priority assessment is respiratory rate before each dose

acetaminophen (Tylenol)

non-opioid analgesic and antipyretic

Use: management of mild to moderate pain and fever reduction

Maximum adult dose is 4 grams per day; reduce to 2 grams per day in patients with liver disease or heavy alcohol use
Educate patient to check all OTC medications for acetaminophen content to avoid unintentional overdose
Monitor liver function tests; hepatotoxicity is the major toxicity concern
Assess for chronic alcohol use as it significantly increases liver toxicity risk

Key point: Antidote for overdose is acetylcysteine (Mucomyst); hepatotoxicity is the major concern

prednisone (Deltasone)

corticosteroid (glucocorticoid)

Use: treatment of inflammatory and autoimmune conditions and allergic reactions

Monitor blood glucose; corticosteroids cause hyperglycemia and can unmask or worsen diabetes
Never stop abruptly after long-term use; taper dose to prevent adrenal insufficiency
Monitor for signs of infection; corticosteroids suppress the immune system and mask fever
Teach patient to take with food to reduce GI upset and report weight gain, moon face, and mood changes

Key point: Never discontinue abruptly after prolonged use; adrenal suppression requires tapering

albuterol (ProAir, Ventolin)

short-acting beta-2 adrenergic agonist (SABA) bronchodilator

Use: relief of acute bronchospasm in asthma and COPD

Assess lung sounds, respiratory rate, and oxygen saturation before and after administration
Monitor heart rate; albuterol can cause tachycardia and palpitations
Teach patient correct inhaler technique including spacer use and breath-holding for 10 seconds
If using multiple inhalers, administer bronchodilator (albuterol) before corticosteroid inhaler

Key point: Used first (rescue) in asthma attack; monitor for tachycardia as a common side effect

phenytoin (Dilantin)

hydantoin anticonvulsant

Use: prevention and treatment of generalized tonic-clonic and complex partial seizures

Monitor serum phenytoin levels; therapeutic range is 10 to 20 mcg/mL
Administer IV no faster than 50 mg per minute; rapid IV administration causes cardiovascular collapse
Only mix with normal saline; glucose solution causes precipitation
Teach patient about gingival hyperplasia and emphasize oral hygiene; also can cause hirsutism and ataxia

Key point: IV rate must not exceed 50 mg/minute; monitor for cardiac dysrhythmias and hypotension during IV infusion

lithium (Lithobid)

mood stabilizer

Use: treatment and prevention of manic episodes in bipolar disorder

Monitor serum lithium levels; therapeutic range is 0.6 to 1.2 mEq/L; toxicity occurs above 1.5 mEq/L
Maintain adequate sodium and fluid intake; sodium depletion causes lithium retention and toxicity
Monitor renal and thyroid function; lithium can cause nephrogenic diabetes insipidus and hypothyroidism
Teach patient early toxicity signs: fine hand tremor, nausea, diarrhea, and mild thirst

Key point: Narrow therapeutic index; dehydration and low sodium diet increase toxicity risk

levothyroxine (Synthroid, Levoxyl)

thyroid hormone replacement

Use: treatment of hypothyroidism and thyroid hormone replacement after thyroidectomy

Administer on an empty stomach 30 to 60 minutes before breakfast for optimal absorption
Do not take within 4 hours of calcium, iron, or antacids as they reduce absorption
Monitor TSH levels to assess therapeutic response; normal TSH indicates adequate dosing
Teach patient signs of excessive dosing: palpitations, chest pain, nervousness, heat intolerance, and weight loss

Key point: Take on empty stomach consistently; monitor TSH to assess adequacy of therapy

potassium chloride (K-Dur, Klor-Con)

electrolyte replacement

Use: treatment and prevention of hypokalemia

IV potassium must always be diluted; never administer as undiluted IV push as it can cause cardiac arrest
IV infusion rate should not exceed 10 to 20 mEq per hour; monitor cardiac rhythm during IV administration
Oral potassium should be taken with food or a full glass of water to reduce GI irritation
Monitor serum potassium, ECG, urine output, and renal function throughout therapy

Key point: Never give IV potassium undiluted or as IV push; fatal cardiac arrest can result

metformin (Glucophage)

biguanide antidiabetic

Use: first-line treatment of type 2 diabetes mellitus

Hold 24 to 48 hours before and after IV contrast dye procedures due to risk of lactic acidosis
Monitor renal function; contraindicated when GFR is less than 30 mL/min/1.73m2
Most common side effects are GI: nausea, diarrhea, and abdominal discomfort; take with meals to minimize
Does not cause hypoglycemia when used as monotherapy; low risk compared to sulfonylureas

Key point: Hold before IV contrast; risk of lactic acidosis in renal impairment is the key safety concern

atorvastatin (Lipitor)

HMG-CoA reductase inhibitor (statin)

Use: treatment of hyperlipidemia and prevention of cardiovascular disease

Monitor liver function tests at baseline and periodically during therapy
Instruct patient to report unexplained muscle pain, tenderness, or weakness immediately (myopathy or rhabdomyolysis)
Avoid grapefruit juice as it inhibits metabolism and increases statin concentration and toxicity
Administer at bedtime as cholesterol synthesis is highest overnight, though atorvastatin can be given any time

Key point: Monitor for myopathy and rhabdomyolysis; check CK levels if muscle pain occurs

nitroglycerin (Nitrostat, Nitro-Bid)

nitrate vasodilator

Use: treatment and prevention of angina pectoris and acute coronary syndromes

Instruct patient to sit or lie down before taking sublingual nitroglycerin to prevent falls from hypotension
May repeat sublingual dose every 5 minutes for up to 3 doses; call 911 if chest pain unrelieved after first dose
Rotate transdermal patch sites and remove old patch before applying new one; remove at night to prevent tolerance
Store sublingual tablets in original dark glass bottle; replace every 6 months as potency diminishes

Key point: Headache and hypotension are common; call emergency services if chest pain persists after 3 sublingual doses in 15 minutes

naloxone (Narcan)

opioid antagonist

Use: reversal of opioid-induced respiratory depression and opioid overdose

Duration of naloxone is shorter than most opioids; patient may lapse back into respiratory depression and require redosing
Monitor respiratory rate, oxygen saturation, and level of consciousness continuously after administration
May precipitate acute opioid withdrawal in opioid-dependent patients: agitation, nausea, vomiting, and tachycardia
Intranasal and IM formulations are available for community use in opioid overdose emergencies

Key point: Shorter half-life than opioids; monitor closely for return of respiratory depression after initial reversal

magnesium sulfate

electrolyte and anticonvulsant

Use: prevention and treatment of seizures in preeclampsia and eclampsia; treatment of hypomagnesemia

Monitor respirations, deep tendon reflexes (DTRs), and urine output; hold if respirations are less than 12 or DTRs are absent
Have calcium gluconate available at bedside as the antidote for magnesium toxicity
Monitor serum magnesium levels; therapeutic anticonvulsant range is 4 to 7 mEq/L; toxicity above 7 mEq/L
Assess urine output; minimum of 25 to 30 mL per hour required for safe magnesium excretion

Key point: Antidote is calcium gluconate; loss of deep tendon reflexes is the earliest sign of toxicity

vancomycin (Vancocin)

glycopeptide antibiotic

Use: treatment of serious gram-positive infections including MRSA

Monitor serum vancomycin trough levels before the fourth dose; therapeutic trough is 10 to 20 mcg/mL
Monitor renal function (BUN and creatinine) and urine output; vancomycin is nephrotoxic
Infuse IV slowly over at least 60 minutes to prevent Red Man Syndrome: flushing, erythema, and hypotension
Monitor for ototoxicity: tinnitus and hearing loss, especially with concurrent aminoglycoside use

Key point: Red Man Syndrome from rapid infusion is prevented by slowing infusion rate; monitor renal function and trough levels

amiodarone (Cordarone, Pacerone)

class III antiarrhythmic

Use: treatment of life-threatening ventricular dysrhythmias and atrial fibrillation

Monitor thyroid function tests; amiodarone contains iodine and can cause both hypothyroidism and hyperthyroidism
Assess for pulmonary toxicity: new or worsening cough, dyspnea, and chest pain; obtain baseline and periodic chest X-ray
Monitor for corneal microdeposits and advise patient to report visual changes; regular ophthalmology exams recommended
Monitor liver function tests; hepatotoxicity can occur with long-term use

Key point: Multiple organ toxicities (pulmonary, thyroid, hepatic, corneal); requires baseline and ongoing monitoring of multiple systems

sertraline (Zoloft)

selective serotonin reuptake inhibitor (SSRI)

Use: treatment of major depressive disorder, anxiety disorders, PTSD, and OCD

Black box warning: increased risk of suicidal ideation in children, adolescents, and young adults up to age 24; monitor closely especially in first weeks
Full therapeutic effect takes 4 to 6 weeks; educate patient not to stop medication if they do not feel immediate improvement
Do not discontinue abruptly; taper to prevent serotonin discontinuation syndrome: dizziness, flu-like symptoms, and irritability
Monitor for serotonin syndrome with concurrent use of other serotonergic drugs: hyperthermia, agitation, and muscle rigidity

Key point: Black box warning for suicidality in young patients; monitor closely in first few weeks of therapy

aspirin (Bayer, Ecotrin)

salicylate, antiplatelet, NSAID

Use: antiplatelet therapy for prevention of myocardial infarction and stroke; pain and fever relief

Assess for aspirin allergy and cross-reactivity with NSAIDs before administration
Monitor for GI bleeding: black tarry stools, hematemesis; take with food or milk to reduce GI irritation
Teach patient to recognize salicylate toxicity (salicylism): tinnitus, hearing loss, dizziness, and tachypnea
Do not give aspirin to children or teenagers with viral illness due to risk of Reye syndrome

Key point: Contraindicated in children with viral illness due to Reye syndrome; tinnitus is an early sign of toxicity

enoxaparin (Lovenox)

low molecular weight heparin (LMWH) anticoagulant

Use: prevention and treatment of deep vein thrombosis and pulmonary embolism

Administer subcutaneously in the abdomen; do not aspirate or rub the injection site after administration
aPTT monitoring is generally not required for routine dosing unlike unfractionated heparin; anti-Xa levels used if monitoring needed
Use with caution in patients with renal impairment; dose adjustment required when GFR is less than 30 mL/min
Assess for heparin-induced thrombocytopenia (HIT) and monitor platelet counts; cross-reactivity with heparin is possible

Key point: Do not rub injection site after administration; protamine sulfate only partially reverses LMWH anticoagulation

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High-Yield Nursing Drug Guide – Free NCLEX Pharmacology Cards